Fluoride and Water

Keeping kids' teeth healthy requires more than just daily brushing. During a routine well-child exam, you may be surprised to find the doctor examining your child's teeth and asking you about your water supply. That's because fluoride, a substance that's found naturally in water, plays an important role in healthy tooth development and cavity prevention.

What Is Fluoride?

Fluoride exists naturally in water sources and is derived from fluorine, the thirteenth most common element in the Earth's crust. It is well known that fluoride helps prevent and even reverse the early stages of tooth decay.

Tooth decay occurs when plaque — that sticky film of bacteria that accumulates on your teeth — breaks down sugars in food. The bacteria produce damaging acids that dissolve the hard enamel surfaces of teeth. If the damage is not stopped or treated, the bacteria can penetrate through the enamel causing tooth decay (also called cavities or caries). Cavities weaken teeth and can lead to pain, tooth loss, or even widespread infection in the most severe cases.

Fluoride combats tooth decay in two ways. It is incorporated into the structure of developing teeth when it is ingested and also works when it comes in contact with the surface of the teeth. Fluoride prevents the acid produced by the bacteria in plaque from dissolving, or demineralizing, tooth enamel, the hard and shiny substance that protects the teeth. Fluoride also allows teeth damaged by acid to repair, or remineralize, themselves. Fluoride cannot repair cavities, but it can reverse low levels of tooth decay and thus prevent new cavities from forming.

Despite the good news about dental health, tooth decay remains one of the most common diseases of childhood. According to the Centers for Disease Control and Prevention (CDC), more than one quarter of 2- to 5-year-olds and half of kids 12 to 15 years old have one or more cavities, and tooth decay has affected two thirds of 16- to 19-year-olds.

Fluoride and the Water Supply

For over 60 years, water fluoridation has proved to be a safe and cost-effective way to reduce dental caries. Today, water fluoridation is estimated to reduce tooth decay by 20-40%. As of 2002, the CDC statistics show that almost 60% of the U.S. population receives fluoridated water through the taps in their homes. Some communities have naturally occurring fluoride in their water; others add it at water-processing plants.

Your child's doctor or dentist may know whether local water supplies contain optimal levels of fluoride, between 0.7 and 1.2 ppm (parts fluoride per million parts of water). If your water comes from a public system, you could also call your local water authority or public health department, or check online at the Environmental Protection Agency's (EPA) database of local water safety reports. If you use well water or water from a private source, fluoride levels should be checked by a laboratory or public health department.

Some parents purchase bottled water for their children to drink instead of tap water. Most bottled waters lack fluoride, but fluoridated bottled water is now available. If fluoride is added, the manufacturer is required to list the amount. If fluoride concentration is greater than 0.6 ppm up to 1.0 ppm, you might see the health claim "Drinking fluoridated water may reduce the risk of tooth decay" on the label.

The Controversy Over Fluoride

Opponents of water fluoridation have questioned its safety and effectiveness; however, there has been little evidence to support these claims.

Scientific research continues to support the benefits of fluoride when it comes to prevention of tooth decay and its safety at current recommended levels of 0.7 to 1.2 ppm. Dramatic reductions in tooth decay in the past 30 years is attributed to fluoridation of the water supply, and parents and health professionals should continue to ensure that kids receive enough fluoride to prevent cavities.

The American Dental Association (ADA), the United States Public Health Service (USPHS), the American Academy of Pediatric (AAP), and the World Health Organization (WHO), among many other national and international organizations, endorse community water fluoridation. The CDC recognized fluoridation of water as one of the 10 greatest public health achievements of the 20th century.

Kids' Fluoride Needs

So how much fluoride do kids need? In general, kids under the age of 6 months do not need fluoride supplements. Your child's 6-month checkup offers a great chance to discuss fluoride supplementation with a health professional. If you live in a nonfluoridated area, your doctor or dentist may prescribe fluoride drops, tablets, or vitamins after your baby is 6 months old.

The AAP recommends that these fluoride supplements be given daily to kids between the ages of 6 months and 16 years. The dosage depends on how much fluoride naturally occurs in the water and the child's age. Only kids living in nonfluoridated areas or those who drink only nonfluoridated bottled water should receive supplements.

What about toothpastes, mouth rinses, and other products that contain fluoride? Here are a few tips:

• Kids under 2 years old should not use fluoride toothpaste unless instructed by a dentist or health professional.
• Kids younger than 6 may swallow too much toothpaste while brushing, so should be supervised when brushing and taught to spit, not swallow, toothpaste.
• Kids over age 2 should use a fluoride-containing toothpaste that carries the ADA's seal of acceptance.
• Kids should use only a pea-sized amount of toothpaste.
• Kids under age 6 should never use fluoride-containing mouth rinses. However, older kids at high risk for tooth decay may benefit from using them. Your dentist can talk with you about risk factors such as a family history of dental disease, recent periodontal surgery or disease, or a physical impediment to brushing regularly and thoroughly.

Your family dentist or pediatric dentist (one who specializes in the care of children's teeth) is a great resource for information about dental care and fluoride needs. A dentist can help you understand more about how fluoride affects the teeth, and once all of your child's primary teeth have come in, may recommend regular topical fluoride during routine dental visits.

Overexposure to Fluoride

If some fluoride is good, why isn't more fluoride better? As with most medications, including vitamins and mineral supplements, too much can be harmful. Most kids get the right amount of fluoride through a combination of fluoridated toothpaste and fluoridated water or supplements.

Too much fluoride before 8 years of age, a time when teeth are developing, can cause enamel fluorosis, a discoloration or mottling of the permanent teeth For most, the changes are subtle. In one study, 94% of identified fluorosis cases were very mild to mild. Most cases are due to inappropriate use of fluoride-containing dental products, including toothpaste and mouth rinses. Sometimes kids take daily fluoride supplements but may be getting adequate fluoride from other sources, which also puts them at risk.

Recently, the National Research Council found naturally occurring fluoride levels exceeded the optimal levels used in community fluoridation programs (0.7 to 1.2 ppm), putting kids under 8 years old at risk for severe enamel fluorosis. The CDC recommends that in communities where fluoride levels are greater than 2 ppm, parents should provide kids with water from other sources.

The ADA also recognizes that infants need less fluoride than older kids and adults. Some infants may be getting too much fluoride in the water used to reconstitute infant formula. If you're concerned that your infant may be getting too much fluoride, talk with your doctor or dentist, who may recommend ready-to-feed formula or formula reconstituted with fluoride-free or low-fluoride water.

Very rarely, fluoride toxicity can occur when large amounts of fluoride are ingested during a short period of time. Kids under age 6 account for more than 80% of reports of suspected overingestion. Although outcomes are generally not serious, fluoride toxicity sends several hundred children to emergency rooms each year.

Symptoms of fluoride toxicity may include nausea, diarrhea, vomiting, abdominal pain, increased salivation, or increased thirst. Symptoms begin 30 minutes after ingestion and can last up to 24 hours. If you suspect your child may have eaten a substantial amount of a fluoridated product or supplement, call the poison control center or 911.

Be sure to keep toothpaste, supplements, mouth rinses, and other fluoride-containing products out of children's reach or in a locked cabinet. You should also supervise your young child's toothbrushing sessions to prevent swallowing of toothpaste or other fluoridated products.

If you have any questions about your water's fluoride content, the fluoridated products your child uses, or whether your child is receiving too much or too little fluoride, talk to your doctor or dentist.

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How Does Fluoride Work?

There's fluoride in your toothpaste and even in your water. But how does it work to keep teeth healthy? Let's find out.

Fluoride is a natural element found in the earth's crust as well as in water and air. It's also considered a nutrient because our bodies need fluoride to grow and develop properly. Decades ago, scientists discovered that kids who naturally had more fluoride in their drinking water had fewer cavities. In the mid-1940s, communities started to put more fluoride in their water supplies to protect people against tooth decay.

Fluoride helps because, when teeth are growing, it mixes with tooth enamel — that hard coating on your teeth. That prevents tooth decay, or cavities. But fluoride can help even after your teeth are formed. It works with saliva to protect tooth enamel from plaque and sugars. By using fluoride toothpaste, for instance, everyone can enjoy some cavity protection. Fewer cavities means healthier teeth when you're an adult — and less chance of having to wear false teeth (dentures) when you're old!

So how do you get your fluoride? Ask your dentist the next time you have an appointment. In addition to fluoride toothpaste, he or she might recommend a mouthwash that has fluoride in it. And if your drinking water doesn't have fluoride in it, your dentist might suggest supplements — which are like vitamins containing fluoride.

Just how effective is fluoridated water? Thanks to it, dentists say half of kids between 5 and 17 have never had a cavity in their permanent teeth. We hope you're one of them!

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Preventing Decay with Fluoride

What is fluoride?

Fluoride is a mineral that is naturally present in varying amounts in almost all foods and water supplies. Fluoride is also used in many consumer dental products such as toothpaste and fluoride mouth rinses.

How does fluoride reduce tooth decay?

Fluoride acts in two ways: topically and systemically. Topical fluorides strengthen teeth that have already erupted into the mouth. As the fluoride washes over the tooth surface, it is incorporated into the outer surface of the tooth, making it more resistant to decay. Additionally, topical fluoride is used to protect and desensitize root surfaces by providing additional mineralization to the naturally occurring “softer” root surface.

Systemic fluorides are those that are ingested through food and water and are used by the body as teeth are formed. Systemic fluorides, if ingested regularly during tooth formation, will be deposited throughout the developing layer of enamel, creating a stronger, more decay resistant outer layer. Systemic fluorides also protect teeth topically, as the fluoride is present in saliva, which continually bathes the teeth, promoting remineralization or repair of tooth surfaces that have been damaged by acids early in the decay process. Additionally, fluoride becomes incorporated into the dental plaque layer and can contribute further to the remineralization process.

How can I get fluoride?

Topical fluoride comes from use of fluoride containing toothpastes, mouth rinses, and gels, which are placed directly onto the teeth. Children are routinely provided with topical fluoride applications at their dental checkup visits, as this is one of the most effective ways of providing the benefits of topical fluoride to newly erupted teeth. Additionally, depending on the level of decay activity or root surface sensitivity you or your child are experiencing, your CDA member dentist may prescribe a product with more available fluoride than can be found in over-the-counter products.

Systemic fluoride is available through community water supplies that either have naturally occurring levels of fluoride that are optimal or have had fluoride added to reach optimal levels. In communities without fluoridated water supplies, systemic fluoride is available through bottled water purchased specifically for its fluoride content or through fluoride tablets or vitamins prescribed by your CDA dentist or your child’s pediatrician. Remember, in order for fluoride to exert systemic benefits, it must be ingested. So, if you do not live in a community with fluoridated water, consult your dentist or physician about the need for another method of fluoride supplementation.

Who benefits from fluoride?

Everyone can benefit from fluoride’s ability to help prevent tooth decay. Unfortunately, only 30 percent of California’s water supply is fluoridated, which means that large portions of California’s population are without the systemic benefits that fluoride provides. If your community is considering fluoridating its water supply, it is in your best interests to support these efforts, not only for yourself and your children, but for all those members of your community that do not have access to dental care and other means of fluoride supplementation and the cavity protection it provides.

If some fluoride is good, is more fluoride better?

The benefits of fluoride have been well known for over 50 years and are supported by numerous health and professional organizations, including the California Dental Association, the American Dental Association, The American Medical Association, the United States Centers for Disease Control and Prevention, the US Public Health Service and the World Health Organization. However, as with nearly all substances we ingest, there are levels that are safe, levels that are optimal, and levels that can cause negative effects. When fluoride is ingested above optimal levels, a condition called dental fluorosis can result. While dental fluorosis is not harmful, it may cause discoloration, or white spots, on your child’s teeth.

Parents should be aware of the sources of systemic fluoride their child receives. If your community water supply is fluoridated, then that will supply the optimal amount of systemic fluoride and tablets or vitamins should not be ingested. Additionally, young children (those who cannot spit after brushing their teeth) should only use a pea-sized amount of fluoride toothpaste to ensure that unmeasured amounts of fluoride are not ingested.

What to remember?

Fluoride alone will not prevent tooth decay; it is only one of the tools necessary for maintaining strong teeth and positive oral health. Remember to brush your teeth at least twice a day with a fluoridated toothpaste, floss daily, eat a balanced diet, and limit the frequency of snacking, especially sweet and sticky foods. Just as important, visit your CDA dentist regularly and follow his or her recommendations for your family’s optimal oral health.

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Oral health

Oral health: What's behind your smile

You use your mouth to speak, eat, kiss and smile, among other tasks. The key to keeping everything working well is good oral health. Having healthy teeth and gums isn't a given, though. Preventing tooth decay and other oral health problems takes effort. Start on the path toward good oral health by understanding what's behind your smile — your teeth, gums, tongue and salivary glands.

Teeth: From crown to root

Adults have 32 permanent teeth, including wisdom teeth. Each tooth has two main parts — the crown and the root. The crown is the part of the tooth you can see, and the root is hidden below your gums.

Other parts of the tooth include:

• Enamel. Enamel is the hard outer coating of the crown of the tooth.
• Dentin. Dentin is a hard substance beneath the enamel that makes up the bulk of the tooth.
• Pulp. Pulp is the soft tissue in the middle of the tooth.
• Cementum. Cementum covers the root of the tooth and attaches it to the jawbone.

Gums: Pink means healthy

Your gums (gingivae) surround your teeth to help hold them in place. To keep your gums healthy, practice good oral hygiene — brush your teeth at least twice a day, floss your teeth once a day and schedule regular dental visits. If your gums become red and swollen or bleed easily, they may be infected. This is known as gingivitis. Prompt treatment can help restore good oral health. Left untreated, gingivitis may progress to severe gum disease (periodontitis) and possible tooth loss.

Tongue: From talking to tasting

Your tongue is a muscular organ that helps you speak and move food for chewing and swallowing. Small bumps called papillae (puh-PIL-e) cover your tongue's upper surface. Between the papillae are taste buds. The taste buds allow you to enjoy specific tastes, such as bitter, sour, salty and sweet. Your tongue also plays a role in oral health. Food particles can stick to your tongue, causing bad breath and tooth decay. To take good care of your tongue, simply brush your tongue whenever you brush your teeth.

Salivary glands: Aiding digestion, preventing decay

Your mouth has three major pairs of salivary glands — the parotid, sublingual and submandibular glands — as well as numerous smaller glands. These glands produce and secrete saliva. In addition to helping you swallow and digest food, saliva promotes oral health by:

• Flushing food away from your mouth
• Stopping acids that can attack tooth enamel
• Replenishing minerals in tooth enamel
• Killing or reducing disease-causing organisms

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Taking care of your teeth

Dentists say that the most important part of tooth care happens at home. Brushing and flossing properly, along with regular dental checkups, can help prevent tooth decay and gum disease.

If you're like most people, you don't exactly look forward to facing a dentist's drill. So wouldn't it be better to prevent cavities before they begin?

Giving Plaque the Brush-Off

To prevent cavities, you need to remove plaque, the transparent layer of bacteria that coats the teeth. The best way to do this is by brushing your teeth twice a day and flossing at least once a day. Brushing also stimulates the gums, which helps to keep them healthy and prevent gum disease. Brushing and flossing are the most important things that you can do to keep your teeth and gums healthy.

Toothpastes contain abrasives, detergents, and foaming agents. Fluoride, the most common active ingredient in toothpaste, is what prevents cavities. So you should always be sure your toothpaste contains fluoride.

About 1 person in 10 has a tendency to accumulate tartar quickly. Tartar is plaque in a hardened form that is more damaging and difficult to remove. Using anti-tartar toothpastes and mouthwashes, as well as spending extra time brushing the teeth near the salivary glands (the inside of the lower front teeth and the outside of the upper back teeth) may slow the development of new tartar.

If you have teeth that are sensitive to heat, cold, and pressure, you may want to try a special toothpaste for sensitive teeth. But you'll still need to talk to your dentist about your sensitivity because it may indicate a more serious problem, such as a cavity or nerve inflammation (irritation).

Tips on Proper Brushing

Dentists say that the minimum time you should spend brushing your teeth is 2 minutes twice a day. Here are some tips on how to brush properly:

• Hold your brush at a 45-degree angle against your gumline. Gently brush from where the tooth and gum meet to the chewing surface in short (about half-a-tooth-wide) strokes. Brushing too hard can cause receding gums, tooth sensitivity, and, over time, loose teeth.
• Use the same method to brush all outside and inside surfaces of your teeth.
• To clean the chewing surfaces of your teeth, use short sweeping strokes, tipping the bristles into the pits and crevices.
• To clean the inside surfaces of your top and bottom front teeth and gums, hold the brush almost vertical. With back and forth motions, bring the front part of the brush over the teeth and gums.
• Using a forward-sweeping motion, gently brush your tongue and the roof of your mouth to remove the decay-causing bacteria that exist in these places.
• Use an egg timer or play a favorite song while brushing your teeth to get used to brushing for a full 2 to 3 minutes. Some electronic toothbrushes have timers that let you know when 2 minutes are up.

Facts on Flossing

Brushing is important but it won't remove the plaque and particles of food between your teeth, under the gumline, or under braces. You'll need to floss these spaces at least once a day.

The type of floss you choose depends on how much space you have between your teeth. Dentists usually recommend unwaxed floss because it's thinner and easier to slide through small spaces. However, studies have shown that there is no major difference in the effectiveness based on the type of floss used.

With any floss, you should be careful to avoid injuring your gums. Follow these instructions:

• Carefully insert the floss between two teeth, using a back and forth motion. Gently bring the floss to the gumline, but don't force it under the gums. Curve the floss around the edge of your tooth in the shape of the letter "C" and slide it up and down the side of each tooth.
• Repeat this process between all your teeth, and remember to floss the back sides of your back teeth.

Tooth-Whitening Products

Some toothpastes claim to whiten teeth. There's nothing wrong with using whitening toothpastes as long as they also contain fluoride and ingredients that fight plaque and tartar. But these toothpastes alone don't contain much in the way of whitening ingredients and probably won't noticeably change the color of your teeth.

It's easy to be lured by ads telling people they need gleaming white teeth. But these ads are really targeted to older people. The truth is that most teens don't need tooth whitening because teeth usually yellow as a person gets older. If you think your teeth aren't white enough, though, talk to your dentist before you try any over-the-counter whitening products. Your dentist may be able to offer you professional treatment, which will be suited to your unique needs and will work better than over-the-counter products.

Be careful when buying over-the-counter whitening products. Some bleaching agents may damage your gums and mouth. So always follow the instructions on any whitening product you use.

The Nutrition Connection

Eating sugar, as you probably already know, is a major cause of tooth decay. But it's not just how much sugar you eat — when and how you eat it can be just as important to keeping teeth healthy.

When you eat sugary foods or drink sodas frequently throughout the day, the enamel that protects your teeth is constantly exposed to acids. Hard candies, cough drops, and breath mints that contain sugar are especially harmful because they dissolve slowly in your mouth. Many experts suggest that you take a 3-hour break between eating foods containing sugar.

Sugary or starchy foods eaten with a meal are less harmful to your teeth than when they're eaten alone, possibly because the production of saliva, which washes away the sugar and bacteria, is increased. Eating sugary foods before you go to bed can be the most damaging (especially if you don't brush your teeth afterward) because you don't produce as much saliva when you sleep.

For most people, it's hard to cut out sweets completely, so try to follow these more realistic guidelines:

• Eat carbohydrates (sugars and starches) with a meal.
• If you can't brush your teeth after eating, rinse your mouth with water or mouthwash, or chew sugarless gum.
• Don't eat sugary foods between meals.
• If you snack, eat nonsugary foods, such as cheese, popcorn, raw veggies, or yogurt.

Going to the Dentist

The main reason for going to the dentist regularly — every 6 months — is prevention. The goal is to prevent tooth decay, gum disease, and other disorders that put the health of your teeth and mouth at risk.

Your first consultation with a dentist will probably consist of three main parts: a dental and medical history (where the dentist or dental hygienist asks you questions about your tooth care and reviews any dental records), a dental examination, and a professional cleaning.

The dentist will examine your teeth, gums, and other mouth tissues. He or she may also examine the joints of your jaws. The dentist will use a mirror and probe (a metal pick-like instrument) to check the crown (visible part) of each tooth for plaque and evidence of looseness or decay. The dentist also will check your bite and the way your teeth fit together (called occlusion).

Your dentist will examine the general condition of your gums, which should be firm and pink, not soft, swollen, or inflamed. He or she (or an assistant) will use the probe to check the depth of the sulcus, the slight depression where each tooth meets the gum. Deep depressions, called pockets, are evidence of gum disease.

After examining the visible parts of your teeth and mouth, your dentist will take X-rays that might reveal tooth decay, abscesses (collections of pus surrounded by swollen tissue), or impacted wisdom teeth.

Professional cleaning is usually performed by a dental hygienist, a specially trained and licensed dental professional. Cleaning consists mainly of removing hard deposits using a scaler (a scraping instrument) or an ultrasonic machine, which uses high-frequency sound waves to loosen plaque deposits. The particles are then rinsed off with water.

After cleaning, the dental hygienist will polish your teeth. The process cleans and smoothes the surfaces of the teeth, removing stains and making it harder for plaque to stick to the teeth. Finally, the hygienist may treat your teeth with a fluoride compound or a sealant to help prevent decay.

At the end of your visit, the dentist will let you know if you need to return to fill a cavity. Your dentist also may refer you to an orthodontist if he or she thinks you may need braces or have other issues.

More Dental Problems

Dental caries (tooth decay) can attack the teeth at any age. In fact, 84% of 17-year-olds have the disease. Left untreated, caries can cause severe pain and result in tooth loss. Losing teeth affects how you look and feel about yourself as well as your ability to chew and speak. Treating caries is also expensive. So prevention and early treatment are important.

It may surprise you to know that 60% of 15-year-olds experience gingivitis, the first stage of gum disease. Gingivitis, which involves the gums but not the underlying bone and ligament, is almost always caused by an accumulation of plaque. As with caries, treatment can be expensive.

If you remove plaque regularly and follow good oral hygiene habits, your gums usually will return to their healthy state. However, more serious gum disease can cause gums to swell, turn red, and bleed, and sometimes causes discomfort. How dentists treat gum disease depends on the extent of the disease.

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Gum desease

Do you think gum disease is something that only happens to people your grandparents' age? Think again! Teens can get gum disease too, and it can cause problems from the simply embarrassing (like bad breath) to the serious — like pain and tooth loss (which is both embarrassing and serious!).

What Is Gum Disease?

Gum disease is also known as periodontal (pronounced: per-ee-oh-don-tul) disease.

Periodontal disease is an infection of the tissues and bone that support the teeth. Untreated gum disease can become very serious, causing teeth to become loose or fall out.

Gum disease is usually caused by a buildup of plaque, an invisible sticky layer of germs that forms naturally on the teeth and gums. Plaque contains bacteria, which produce toxins that irritate and damage the gums.

Hundreds of types of bacteria live in the mouth, so keeping plaque at bay is a constant battle. That's why brushing and flossing every day — and regular trips to the dentist — are so important.

Who Is at Risk?

Certain things can make teens more likely to develop gum disease. Some may inherit this tendency from their parents. The snacks you eat also can put you at risk of developing gum disease — especially if you grab fries and a soda in the mall after school and aren't able to brush immediately after eating them. You probably know that sugar is bad for your teeth, but you may not know that starchy foods like fries also feed the acids that eat into your tooth enamel.

If you have braces, fending off plaque can be tougher. Plus, some medical conditions (including diabetes and Down syndrome) and certain medicines increase the risk of gum disease.

Running yourself down with a lousy diet, too little sleep, and too much stress leaves you more vulnerable to infection anywhere in the body, including your gums.

Girls have a higher risk of gum disease than guys. Increases in female sex hormones during puberty can make girls' gums more sensitive to irritation. Some girls may notice that their gums bleed a bit in the days before their periods.

For severe — and early — gum problems, though, the real bad guy is tobacco. Not only does smoking lead to bad breath and stained, yellowed teeth but recent research also shows that smoking is a leading cause of gum disease.

According to the American Dental Association (ADA), people who smoke cigarettes and chew tobacco are more likely to have plaque and tartar buildup and to show signs of advanced gum disease. They are also more likely to develop mouth cancer in the future.

How It Progresses

Gum disease progresses in stages. Believe it or not, more than half of teens have some form of gum disease.

Do your gums bleed when you floss or brush your teeth? Chances are you already have the mildest form of gum disease — bleeding gums are usually a sign of gingivitis (pronounced: jin-juh-vy-tus). Other warning signs of gingivitis include gum tenderness, redness, or puffiness.

If plaque from teeth and gums isn't removed by good daily dental care, over time it will harden into a crust called calculus or tartar. Once tartar forms, it starts to destroy gum tissue, causing gums to bleed and pull away from the teeth. This is known as periodontitis (pronounced: per-ee-oh-don-ty-tus), a more advanced form of gum disease.

With periodontitis, gums become weakened and form pockets around the base of teeth. Bacteria pool in these pockets, causing further destruction of the gums. As periodontitis spreads, it damages deeper gum tissue and can eventually spread to areas of the jawbone that support the teeth. This can cause teeth to become loose and fall out. Though periodontitis is rare in teens, it can happen. If it's not treated, it can cause real trouble for your teeth.

What should you do to avoid these problems? See your dentist if you notice any of these signs of gum disease:

• bleeding of the gums that occurs regularly when brushing or flossing
• discoloration of gums (healthy gums should look pink and firm, not red, swollen, or tender)
• any sign of gums pulling away from teeth
• bad breath that won't go away
• loose teeth

Tracking It Down and Treating It

Gum disease can be sneaky, sometimes causing little or no pain or irritation before permanent damage is done to your teeth. That's why regular dentist visits are a must. With X-rays and a thorough examination, a dentist or dental hygienist can spot trouble before you know it's there.

The earlier that gum disease is caught, the better. Adopting better brushing and flossing habits can usually reverse gingivitis. Sometimes your dentist will also prescribe antibiotics or a special antibacterial mouth rinse to tackle the problem.

Once someone develops periodontitis, it isn't as easy to control. Usually there is widespread infection of the gums that needs to be treated. This may require several special treatments either by a dentist or a periodontist, an expert who specializes in the care of gum disease.

Some of the ways dentists and periodontists may treat periodontitis are:

• Scaling or root planing. These deep-cleaning measures involve scraping and removing plaque and tartar from teeth above and below the gum line.
• Antibiotics. These and other medications are often used together with scaling and root planing to stop the spread of infection and inflammation in the mouth. They come in several different forms that range from medicated mouthwashes to antibiotic-containing gels or fibers that are placed in gum pockets to slowly kill bacteria and help gums to heal.
• Surgery. Advanced cases of periodontitis may require a dentist to open and clean badly diseased gum pockets, then stitch the gums back into place to fit more snugly around the teeth.
• Gingival grafting. If gum tissue is too diseased to sew back together, a dentist removes healthy gum tissue from another part of the mouth and stitches it into place. The graft replaces the diseased tissue and helps to anchor the teeth, giving them an improved appearance.

While undergoing treatment for periodontitis, it's especially important to take special care of your teeth and gums to see lasting improvement. This includes flossing and brushing every day and quitting habits that mean bad news for the mouth, such as smoking or eating sugary snacks between meals.

Prevention Tips

Fortunately, there's good news: Gum disease is usually preventable. Just take care of your teeth, starting now. Don't wait!

• Brush twice a day for at least 3 minutes each time (about the length of your favorite song) and floss daily. If you're not sure whether you're brushing or flossing properly, your dentist or dental hygienist can show you the best techniques.
• Always brush with a toothpaste that contains fluoride; some dentists also recommend daily mouth rinses containing fluoride.
• Use a toothbrush with soft, polished bristles, as these are less likely to irritate or injure gum tissue. Be sure to replace your toothbrush at least every 3 to 4 months — a worn-out toothbrush can injure your gums. (Some toothbrush brands contain color indicators on the bristles to remind you to replace them when they become worn.)
• Eat a healthy diet. Avoid snacks and junk foods packed with sugar that plaque-causing bacteria love to feed on.
• Don't smoke! Cigarettes and chewing tobacco cause mouth irritation and are very unhealthy for gums and teeth.
• Regular dental care is extremely important in helping to keep your mouth healthy. Visit your dentist for routine care — especially cleaning — at least twice a year. Your dentist can remove hardened plaque and any tartar that you're not getting to with brushing or flossing.

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All About Orthodontia

Why Do People Need Braces?

Braces are a totally normal and practically expected part of puberty (and many adults get braces, too). To better understand why braces and other orthodontic devices are needed, it helps to talk a bit about the teeth first.

As you made your way through childhood, your "baby" teeth fell out one by one, to be replaced by permanent, adult teeth. Although some people's adult teeth grow in at the right angle and with the right spacing, many people's teeth don't.

Some teeth may grow in crooked or overlapping. In other people, some teeth may grow in rotated or twisted. Some people's mouths are too small, and this crowds the teeth and causes them to shift into crooked positions.

And in some cases, a person's upper jaw and lower jaw aren't the same size. When the lower half of the jaw is too small, it makes the upper jaw hang over when the jaw is shut, resulting in a condition called an overbite. When the opposite happens (the lower half of the jaw is larger than the upper half), it's called an underbite.

All of these different types of disorders go by one medical name: malocclusion. This word comes from Latin and means "bad bite." In most cases, a "bad bite" isn't anyone's fault; crooked teeth, overbites, and underbites are often inherited traits, just like brown eyes or big feet are inherited traits.

In some cases, things like dental disease, early loss of baby or adult teeth, some types of medical problems, an accident, or a habit like prolonged thumb sucking can cause the disorders.

Malocclusion can be a problem because it interferes with proper chewing — crooked teeth that aren't aligned properly don't work as well as straight ones. Because chewing is the first part of eating and digestion, it's important that teeth can do the job. Teeth that aren't aligned correctly can also be harder to brush and keep clean, which can lead to tooth decay and cavities. And finally, many people who have crooked teeth may feel self-conscious about how they look; braces can help them feel better about their smile and whole face.

If a dentist suspects that a kid or teen needs braces or other corrective devices, he or she will refer the patient to an orthodontist. Orthodontists are dentists who have special training in the diagnosis and treatment of misaligned teeth and jaws. Most regular dentists can tell if teeth will be misaligned once a patient's adult teeth begin to come in — sometimes as early as age 6 or 7 — and the orthodontist may recommend interceptive treatment therapy. (Interceptive treatment therapy involves the wearing of appliances to influence facial growth and help teeth grow in better, and helps prevent more serious problems from developing.) In many cases, the patient won't be referred to an orthodontist until closer to the teen years.

Diagnosis

Before giving someone braces, the orthodontist needs to diagnose what the problem is. This means making use of several different tools, including X-rays, photographs, and impressions.

The X-rays give the orthodontist a good idea of where the teeth are positioned and if any more teeth have yet to come through the gums. Special X-rays that are taken from 360 degrees around the head may also be ordered; this type of X-ray shows the relationships of the teeth to the jaws and the jaws to the head.

The orthodontist may also take regular photographs of the patient's face to help him or her understand these relationships better. And finally, the orthodontist may need an impression made of the patient's teeth. This is done by having the patient bite down on a mushy material that is used later to form an exact copy of the teeth.

Treatment

Once a diagnosis is made, the orthodontist can then decide on the right kind of treatment. In some cases, a removable retainer will be all that's necessary. In other rare cases (especially when there is an extreme overbite or underbite), an operation will be necessary. But in most cases, the answer is braces.

Braces straighten teeth because they do two very important things: stay in place for an extended amount of time, and exert steady pressure. It's this combination that allows braces to successfully change the arrangement of teeth in a patient's mouth, periodically adjusted by the orthodontist.

Different Types of Braces

An orthodontist can outfit patients with a few different kinds of braces. Some braces are made of a lightweight metal and go around each tooth, while other metal ones are attached to the outside surfaces of the teeth with special glue. Clear braces can be attached to the outside surfaces of the teeth, as can ceramic ones that are the same color as teeth. Some patients can get newer "mini-braces," which are much smaller, or "invisible braces," which are affixed to the inside surfaces of the teeth. In many cases, the patient can choose which kind he or she wants.

Once the orthodontist puts on the braces, they will usually remain on the patient's teeth for anywhere from 6 months to 2 years. In some cases, the braces may need to remain on for more than 2 years.

After the amount of time needed for correction has been established for the patient, the orthodontist must work on the other part of the treatment: making sure the braces exert steady pressure. To achieve this, the patient must come for regular visits, usually once a month or so. During the visits, the orthodontist attaches wires, springs, or rubber bands to the braces in order to create more tension and pressure on the teeth. Sometimes the rubber bands will connect certain teeth to one another to create a kind of opposing tension.

With some teens, the orthodontist may decide that extra tension is needed outside the mouth — when braces alone aren't enough to straighten the teeth or shift the jaw. In cases like these, a patient may need to wear head or neck gear with wires that attach inside the mouth and elastic that attaches the gear to the head. Many times, a patient will only need to wear this type of gear at night or in the evening, while at home.

It may take a while, but with the right combination and timing of wires, springs, rubber bands, and sometimes head gear, the teeth will slowly but surely move into their correct positions.

Some of the adjustments can make your mouth feel a bit sore or uncomfortable because the tension tends to make itself felt in more places than your teeth. Most of the time, taking ibuprofen or acetaminophen can help relieve the pain. If you always have a lot of pain after your braces are adjusted, talk to your orthodontist about it; he or she may able to make the adjustments a bit differently.

Caring for Teeth With Braces

Your orthodontist will also make sure that you know how to take special care of your teeth while your braces are on. Braces, wires, springs, rubber bands, and other appliances can act like magnets for food and plaque, which can leave permanent stains on the teeth if not brushed away. Most orthodontists recommend brushing after meals with fluoride toothpaste and taking special care to remove food stuck in braces. Some orthodontists will also prescribe or recommend a fluoride mouthwash, which can get into places in a mouth with braces that a toothbrush can't.

Some people with braces find that they are more prone to canker sores (from the braces hitting the inside surface of the mouth). If this happens, an orthodontist may recommend an over-the-counter medicine that can be placed directly on the canker sore to help heal it.

Faces After Braces

After what can seem like a long time to someone who has braces, the magic day finally comes: the orthodontist takes the braces off! After your teeth are cleaned thoroughly, the orthodontist may actually want to repeat the process of taking X-rays and impressions of the teeth. This allows the orthodontist to really check the work, and in the case of X-rays, see if wisdom teeth are now visible.

In some cases, an orthodontist may recommend that a patient have the wisdom teeth pulled if they are starting to come in after the braces have been removed. The reason? The wisdom teeth can cause the newly straightened teeth to shift and move in the mouth.

And speaking of teeth shifting and moving, a very important part of a person's post-braces treatment is retention, or keeping the teeth in their new place. The truth is that most teens, after wearing braces and going for adjustments for up to 2 years or longer, don't want anything to do with the orthodontist or having appliances in their mouths. But even though the teeth have been successfully moved with braces, they are still not completely stable — they need to settle in their corrected positions until the bones, gums, and muscles adapt to the change. This is usually accomplished with the use of retainers, which work by retaining the straight position of the teeth.

Some retainers are made of clear plastic and metal wires that cover the outside surface of the teeth, whereas others are made of rubber. Most retainers need to be worn all the time for the first 6 months, then usually only during sleeping. How long a retainer must be worn depends on the patient — one person might wear it for a few months, while another might have to wear it for several years. Whatever the timeframe, retainers are very important; without them, the teeth could shift back into their old, crooked positions, making all the orthodontist's work and your years of patience useless!

The most important things to remember when you're feeling frustrated about having a face full of braces? That during every school photo where you can't be persuaded to open your mouth because of your braces, there are millions of other people experiencing the same thing. And that no matter what, your braces will come off eventually — and you'll be left with a wonderful, straight smile.

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Canker sores

What Is a Canker Sore?

If you've ever had those open, shallow sores in your mouth and taken a gulp of orange juice — ouch! — you know what a pain canker sores can be. You're not alone, either. About one in five people get recurrent canker sores. So what can you do about them? Read on to find out.

Canker sores, also known as aphthous ulcers, are small sores that occur inside the mouth. You can get them on the tongue and on the inside of the cheeks and lips — the parts of the mouth that can move. They usually pop up alone, but sometimes they show up in small clusters.

Your mouth might tingle or burn before the actual sore appears. Soon, a small red bump rises. Then after a day or so it bursts, leaving an open, shallow white or yellowish wound with a red border. The sores are often painful and can be up to an inch across, although most of them are much smaller. Occasionally, someone who gets canker sores may also develop a fever and feel sluggish and uncomfortable.

The good news is that canker sores are not contagious like some other mouth sores, such as cold sores. So you can't spread canker sores by sharing food or kissing someone. Cold sores, however, are caused by the herpes simplex virus, which can pass from person to person. If you have a sore and you're wondering if it's of the cold or canker variety, just look at where it's located. Cold sores usually appear outside the mouth, around the lips, chin, or nostrils. Canker sores, on the other hand, are always found inside the mouth.

You can also have spots in your mouth when you have an infection such as chickenpox or measles. In some cases of these diseases the rash actually spreads into the mouth. But someone with chickenpox or measles would find spots on other parts of the body as well, easily distinguishing those rashes from canker sores.

What Causes Canker Sores?

No one is certain what causes canker sores. They often first appear between the ages of 10 and 20, although they can occur at any time in a person's life. One thing that doctors have noticed is that although the sores are not contagious, they can run in families. That means if your parents or siblings get canker sores, the genes you share with them make it more likely that you'll develop the sores, too.

There may be a connection between canker sores and stress. If the sores show up around exam time or some other big event in your life, it may be a sign of how much stress you're under. In addition, about twice as many women as men get them. Doctors think that may be due to the difference in male and female hormones, especially because women often get them during certain times in their menstrual cycle. Some research suggests that using products containing sodium lauryl sulfate (SLS), a foaming agent found in most toothpastes and mouthwashes, can be associated with canker sores. Dietary deficiencies, such as not getting enough iron or vitamin B12, may also contribute to some cases of canker sores.

How Are They Treated?

Most canker sores will heal on their own in a few days to a couple of weeks. While you're waiting for them to disappear, there are some things you can do:

• Various over-the-counter medicines can help to take the sting out of canker sores. Carbamide peroxide is a combination of peroxide and glycerin that cleans and coats the sore to protect it. Other over-the-counter remedies have benzocaine, menthol, and eucalyptol in them. These need to be applied repeatedly and may sting at first, but they can numb the sore and cut down on how long it lasts.
• Try brushing and rinsing with toothpastes and mouthwashes that do not contain SLS.
• Some homemade mouthwashes can ease pain as well. Try rinsing your mouth four times a day with a mixture of two ounces of hydrogen peroxide and two ounces of water or a combination of four ounces of water mixed with 1 teaspoon (5 milliliters) of salt and 1 teaspoon of baking soda. Swish the mixture in your mouth for about a minute and then spit it out — do not swallow it!
• Dabbing a mixture of equal parts water and hydrogen peroxide directly on the sore, followed by a bit of milk of magnesia, may reduce discomfort and speed healing.
• Some doctors suggest putting wet black tea bags on sores. Black tea contains tannin, a substance that can relieve pain. You can also find tannin in some over-the-counter medicines.

You'll want to watch what you eat when you have a canker sore. Spicy foods and acidic foods such as lemons or tomatoes can be extremely painful on these open wounds. So can anything sharp, such as nuts or potato chips, which can poke or rub the sore. Be careful when you brush your teeth, too. It's important to keep your mouth clean, but brushing the sore itself with a toothbrush will make it worse.

If you have canker sores that do not get better after a few weeks, if the sores keep coming back, or if they make you feel so sick that you don't want to eat, see your doctor or dentist. Your doctor may want to do blood tests to find out if another condition — such as a vitamin deficiency, a problem with your immune system, or even a food allergy — could be contributing to the sores.

Your doctor or dentist may prescribe a topical medicine or special mouthwash to help heal the sores. If the medicine needs to be applied directly to the sore, first blot the area dry with a tissue. Use a cotton swab to apply a small amount of the medication, and do not eat or drink for at least 30 minutes to make sure that the medicine is not immediately washed away. For severe mouth sores, your doctor or dentist may suggest other medications.

Although they can certainly be a pain, in most cases canker sores aren't that big of a deal.

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What causes bad breath?

Bad breath, or halitosis, can be a major problem, especially when you're about to snuggle with your sweetie or whisper a joke to your friend. The good news is that bad breath can often be prevented with some simple steps.

Bad breath is caused by odor-producing bacteria that grow in the mouth. When you don't brush and floss regularly, bacteria accumulate on the bits of food left in your mouth and between your teeth. The sulfur compounds released by these bacteria make your breath smell.

Certain foods, especially ones like garlic and onions that contain pungent oils, can contribute to bad breath because the oils are carried to your lungs and out through your mouth. Smoking is also a major cause of bad breath.

There are lots of myths about taking care of bad breath. Here are three things you may have heard about bad breath that are not true:

Myth #1: Mouthwash will make bad breath go away.

Mouthwash only gets rid of bad breath temporarily. If you do use mouthwash, look for an antiseptic (kills the germs that cause bad breath) and plaque-reducing one with a seal from the American Dental Association (ADA). When you're deciding which dental products to toss into your shopping cart, it's always a good idea to look for those that are accepted by the ADA. Also, ask your dentist for recommendations.

Myth #2: As long as you brush your teeth, you shouldn't have bad breath.

The truth is that most people only brush their teeth for 30 to 45 seconds, which just doesn't cut it. To sufficiently clean all the surfaces of your teeth, you should brush for at least 2 minutes at least twice a day. Remember to brush your tongue, too — bacteria love to hang out there. It's equally important to floss because brushing alone won't remove harmful plaque and food particles that become stuck between your teeth and gums.

Myth #3: If you breathe into your hand, you'll know when you have bad breath.

Wrong! When you breathe, you don't use your throat the same way you do when you talk. When you talk, you tend to bring out the odors from the back of your mouth (where bad breath originates), which simply breathing doesn't do. Also, because we tend to get used to our own smells, it's hard for a person to tell if he or she has bad breath.

If you're concerned about bad breath, make sure you're taking care of your teeth and mouth properly. Some sugar-free gums and mints can temporarily mask odors, too.

If you brush and floss properly and visit your dentist for regular cleanings, but your bad breath persists, you may have a medical problem like sinusitis or gum disease. Call your doctor or dentist if you suspect a problem. They can figure out if something else is behind your bad breath and help you take care of it.

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Things That Can Go Wrong With Teeth

Proper dental care is essential to good oral health. This includes a good diet, brushing and flossing after eating, and regular dental checkups.

Common dental diseases and conditions include:

• Cavities and tooth decay. When bacteria and food particles are allowed to settle on the teeth, plaque forms. The bacteria digest the carbohydrates in the food and produce acid, which dissolves the tooth's enamel and causes a cavity. If the cavity is not treated, the decay process progresses to involve the dentin. Without treatment, serious infection can develop. The most common ways to treat cavities and more serious tooth decay problems are filling the cavity; performing a root canal procedure, which involves the removal of the pulp of a tooth; crowning a tooth with a cap that looks like a tooth made of metal, porcelain, or plastic; or removing or replacing the tooth. To avoid tooth decay and cavities, get in the habit of good dental care — including proper tooth brushing techniques.
• Malocclusion is the failure of the upper and lower teeth to meet properly when you bite down. The types of malocclusion include overbite, underbite, and crowding. Most of these conditions can be corrected with braces. Braces are metal or clear ceramic brackets bonded to the front of each tooth. Wires connecting the brackets are tightened periodically to force the teeth to move into the correct position.
• Impacted wisdom teeth. In many people, the wisdom teeth are unable to erupt normally so they either remain below the jawline or don't grow in properly. Dentists call these teeth impacted. Wisdom teeth usually become impacted because the jaw is not large enough to accommodate all the teeth that are growing in and the mouth becomes overcrowded. Impacted teeth can damage other teeth or become painful and infected. Dentists can check if a person has impacted wisdom teeth by taking X-rays of the teeth. If, after looking at the X-rays, a dentist thinks there's a chance that impacted teeth may cause problems, he or she may recommend that the tooth or teeth be removed (extracted).

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Things That Can Go Wrong With the Mouth

Proper dental care is essential to good oral health. This includes a good diet, brushing and flossing after eating, and regular dental checkups.

Common mouth diseases and conditions include:

• Aphthous stomatitis (canker sores). Canker sores are a common form of mouth ulcer that girls get more often than guys. Although their cause is not completely understood, mouth injuries, stress, dietary deficiencies, hormonal changes (as with the menstrual cycle), or food allergies can trigger them. They usually appear on the inner surface of the cheeks or lips, under the tongue, on the soft palate, or at the base of the gums, and begin with a tingling or burning sensation followed by a painful sore called an ulcer. Pain subsides in 7 to 10 days, with complete healing usually occurring in 1 to 3 weeks.
• Cleft lip and cleft palate are birth defects in which the tissues of the mouth and/or lip don't form properly as a fetus is developing in the womb. Children born with cleft lip or cleft palate can have reconstructive surgery in infancy — and sometimes later — to repair the cleft. This surgery can prevent or lessen the severity of speech problems later in life.
• Enteroviral stomatitis is a common type of infection. People with this condition have small, painful ulcers inside their mouths that may decrease their desire to eat and drink, putting them at risk of dehydration.
• Herpetic stomatitis (oral herpes). Oral herpes causes painful, clustered blisters inside the mouth or on a person's lip. People can get this infection when they have direct contact (such as kissing!) with someone with the herpes simplex virus.
• Periodontal disease. Periodontal (pronounced: pare-ee-oh-don-tul) disease affects the gums and tissues supporting the teeth. Gingivitis (pronounced: jin-jih-vy-tus), an inflammation of the gums characterized by redness, swelling, and sometimes bleeding, is one common form of periodontal disease. It's usually caused by the accumulation of tartar (a hardened film of food particles and bacteria that builds up on teeth). Gingivitis is almost always the result of not brushing and flossing the teeth properly. When gingivitis isn't treated, it can lead to periodontitis, in which the gums loosen around the teeth and pockets of bacteria and pus form, sometimes damaging the supporting bone and causing tooth loss.

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What Do the Mouth and Teeth Do?

The mouth and teeth play an important role in digesting food. Food is torn, ground, and moistened in the mouth. Each type of tooth serves a different function in the chewing process. Incisors cut foods when you bite into them. The sharper, longer canines tear food. The premolars grind and mash food. Molars, with their points and grooves, are responsible for the most vigorous grinding. All the while, the tongue helps to push the food up against our teeth.

As we chew, the salivary glands secrete saliva, which moistens the food and helps break it down further. As well as containing digestive enzymes, saliva makes it easier to chew and swallow foods (especially dry foods).

Once food has been converted into a soft, moist mass, it's pushed into the pharynx at the back of the mouth and is swallowed. When we swallow, the soft palate closes off the nasal passages from the throat to prevent food from entering the nose.

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Normal Development of the Mouth and Teeth

Humans are diphyodont (pronounced: dy-fy-uh-dant), meaning that they develop two sets of teeth. The first set of teeth, the deciduous (pronounced: duh-sid-you-wus) teeth are also called the milk, primary, temporary, or baby teeth. These teeth begin to develop before birth, start to push through the gums between the ages of 6 months and 1 year (this process is called eruption), and usually start to fall out when a kid is around 6 years old. They are replaced by a set of 32 permanent teeth, which are also called secondary or adult teeth.

Although teeth aren't visible at birth, both the deciduous and permanent teeth are forming beneath the gums. By the time a child is 3 years old, he or she has a set of 20 deciduous teeth, 10 in the lower and 10 in the upper jaw. Each jaw has four incisors, two canines, and four molars.

The deciduous teeth help the permanent teeth erupt in their normal positions; most of the permanent teeth form just beneath the roots of the deciduous teeth above them. When a deciduous tooth is preparing to fall out, its root begins to dissolve. This root has completely dissolved by the time the permanent tooth below it is ready to erupt.

The phase during which permanent teeth develop usually lasts for about 15 years as the jaw steadily grows into its adult form. From ages 6 to 9, the incisors and first molars start to come in. Between ages 10 and 12, the first and second premolars, as well as the canines, erupt. From 11 to 13, the second molars come in.

The wisdom teeth (third molars) erupt between the ages of 17 and 21. Sometimes there isn't room in a person's mouth for all the permanent teeth. If this happens, the wisdom teeth may get stuck (or impacted) beneath the gum and may need to be removed. Overcrowding of the teeth is one of the reasons people get braces during their teenage years.

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All About Teeth

The types of teeth are:

• Incisors are the squarish, sharp-edged teeth at the front and middle of the mouth. There are four on the bottom and four on the top.
• To the sides of the incisors are the long, sharp canines, two on the bottom and two on the top. The upper canines are sometimes called eyeteeth.
• Behind the canines are the premolars, or bicuspids. There are two sets, or a total of four premolars, in each jaw — two behind each of the canines on the bottom and two behind each canine on the top.
• The molars, situated behind the premolars, have points and grooves. There are 12 molars in the adult mouth — three sets in each jaw called first, second, and third molars. The third molars are called wisdom teeth. Wisdom teeth get their name because, as the last teeth to erupt, they break through when a person is becoming an adult and is supposedly wiser. Wisdom teeth are not essential today, but some people believe they evolved thousands of years ago when human diets consisted of mostly raw foods that required extra chewing power. Because wisdom teeth can crowd out the other teeth or cause problems like pain and infection, a dentist may need to remove them. This often happens during a person's teenage years.

Each tooth is made of four types of tissue: pulp, dentin, enamel, and cementum. The pulp is the innermost portion of the tooth. Unlike the outer parts of the tooth, the pulp is soft. It is made of connective tissue, nerves, and blood vessels, which nourish the tooth. The pulp has two parts: the pulp chamber, which lies in the crown (or top part of the tooth) and the root canal, which is in the bottom part of the tooth that lies beneath the gums. Blood vessels and nerves enter the root through a small hole at the very bottom of the tooth and extend through the canal into the pulp chamber.

Dentin surrounds the pulp. A hard yellow substance, dentin makes up most of the tooth. It is the dentin that gives the tooth its slightly yellowish tint.

Both the dentin and pulp cover the whole tooth from the crown into the root. But the outermost layer covering the tooth is different, depending on whether it sits above the gum or below it. Enamel, the hardest tissue in the body, covers the crown. Under the gum line, a bony layer of cementum covers the outside of the root and holds the tooth in place within the jawbone. Cementum is as hard as bone but not as hard as enamel, which enables the tooth to withstand the pressure of chewing and protects it from harmful bacteria and changes in temperature from hot and cold foods.

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Mouth and teeth

he first thing that comes to mind when you think of your mouth is probably eating — or kissing! But your mouth's a lot more than an input slot for food or a tool for smooching your sweetie.

Where Would We Be Without Them?

Your mouth and teeth form your smile, which is often the first thing people notice when they look at you. The mouth is also essential for speech: The tongue (which also allows us to taste) enables us to form words with the help of our lips and teeth. The tongue hits the teeth to make certain sounds — the th sound, for example, is produced when the tongue brushes against the upper row of teeth. If a person has a lisp, that means the tongue touches the teeth instead of directly behind them when saying words with the s sound.

Without our teeth, we'd have to live on a liquid diet or a diet of soft, mashed food. The hardest substances in the body, the teeth are necessary for mastication — a fancy way of saying chewing — the process by which we tear, cut, and grind food in preparation for swallowing. Chewing allows enzymes and lubricants released in the mouth to further digest, or break down, food. This makes the mouth one of the first steps in the digestive process. Read on to find out how each aspect of the mouth and teeth plays a role in our daily lives.

Basic Anatomy of the Mouth and Teeth

The mouth is lined with mucous membranes (pronounced: myoo-kus mem-branes). Just as skin lines and protects the outside of the body, mucous membranes line and protect the inside. Mucous membranes make mucus, which keeps them moist.

The membrane-covered roof of the mouth is called the palate. The front part consists of a bony portion called the hard palate, with a fleshy rear part called the soft palate. The hard palate divides the mouth from the nose above. The soft palate forms a curtain between the mouth and the throat (or pharynx — pronounced: fa-rinks) to the rear. The soft palate contains the uvula (pronounced: yoo-vyoo-luh), the dangling fleshy object at the back of the mouth. The tonsils are located on either side of the uvula and look like twin pillars holding up the opening to the pharynx.

A bundle of muscles extends from the floor of the mouth to form the tongue. The upper surface of the tongue is covered with tiny projections called papillae. Our taste buds are located here. The four main types of taste buds — sweet, salty, sour, and bitter — are found on the tongue.

Three pairs of salivary glands in the walls and floor of the mouth secrete saliva, which contains a digestive enzyme called amylase that starts the breakdown of carbohydrates even before food enters the stomach.

The lips are covered with skin on the outside and with slippery mucous membranes on the inside of the mouth. The major lip muscle, called the orbicularis oris (pronounced: or-bik-yoo-lar-iss or-iss), allows for the lips' mobility. The reddish tint of the lips comes from underlying blood vessels, which is why the lips can bleed so easily with injury. The inside part of the lips connects to the gums.

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